Provider Demographics
NPI:1659666980
Name:POWELL, PAULA M (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 TOWNSHIP ROAD 26
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9434
Mailing Address - Country:US
Mailing Address - Phone:419-946-6570
Mailing Address - Fax:
Practice Address - Street 1:3681 TOWNSHIP ROAD 26
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9434
Practice Address - Country:US
Practice Address - Phone:419-946-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 112946 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse